NDAU
National Neonatal Audit Programme
2011-13
Mike Watkinson
National Neonatal Audit Programme 2011-13
•
•
•
•
•
•
Communication
Identity
Consolidation
Change
Two year follow up data
Outliers
National Neonatal Audit Programme 2011-13
• Communication with contributors
– Not just one way
– Not just with NNAP leads
– Data checking
– Clearer definitions and guides
National Neonatal Audit Programme 2011-13
• Communication with parents
– Not just one way
– PREMS and PROMS – how do we achieve them?
National Neonatal Audit Programme 2011-13
• Identity
NDAU
National Neonatal Audit Programme 2011-13
• Identity
BUT
is not
is not
is not
NDAU
National Neonatal Audit Programme 2011-13
• Consolidation
– Existing Audit Questions:
• Nail them down
• Clarify fields used for data
• Use of ad hoc fields
– New Questions
• Fewer
• Reduce lag between introduction & flagging on screen
National Neonatal Audit Programme 2011-13
• Change
– From without:
• Not everyone will always use Badger
• Challenges of clarity and data mapping
– From within:
• Different questions
• Completing the audit cycle
National Neonatal Audit Programme 2011-13
• Different questions – 2012
– Catheter related blood stream infections
– ad hoc fields for data collection
National Neonatal Audit Programme 2011-13
DATA
EXAMPLE
Static
Daily
Ad hoc
Episodic
birth weight, gestation
HRG, CPAP, neurological status, presence of long line
scans, ROP screening, blood culture
discharge destination, milk at discharge
National Neonatal Audit Programme 2011-13
•DATA
Ca
Static
EXAMPLE
birth weight, gestation
Daily
Ad hoc
Episodic
HRG, CPAP, neurological status, presence of long line
scans, ROP screening, infection
discharge destination, milk at discharge
catheter
Stay/episode
1
5
14
30 days
National Neonatal Audit Programme 2011-13
•DATA
Ca
Static
EXAMPLE
birth weight, gestation
Daily
Ad hoc
Episodic
HRG, CPAP, neurological status, presence of long line
scans, ROP screening, infection
discharge destination, milk at discharge
+
-
catheter
Stay/episode
1 2
5
8
14
30 days
National Neonatal Audit Programme 2011-13
The wrong use of
episodic data
+
-
catheter
Stay/episode
1 2
5
8
14
30 days
National Neonatal Audit Programme 2011-13
+
The correct use of ad hoc data
-
catheter
Stay/episode
1 2
5
8
14
30 days
National Neonatal Audit Programme 2011-13
Outliers
The National Clinical Audit
Advisory Group (NCAAG)
has requested that national
audits identify outliers.
National Neonatal Audit Programme 2011-13
Outliers
NNAP will identify outliers starting with the 2011 report.
Detection of potential outliers
• NNAP will create funnel plots of outcomes and approach units
whose performance is >2 SDs below the mean with an ‘alert’
and those >3 SDs below the mean with an ‘alarm’.
• NNAP may also approach units >2 SDs above the mean to
check their data, and to learn from their good practice.
National Neonatal Audit Programme 2011-13
Some audit measures may be more robust than others, and
these will be used for the detection of outliers:
1.
Measurement of temperature within an hour of birth
in babies <28+6 weeks
2.
First ROP screening within one week of the window
designated by national guidelines
3.
Breast milk feeding at discharge home for babies who
stay in one unit all the time
4.
First consultation with parents within 24 hours of a
baby’s admission
National Neonatal Audit Programme 2011-13
• Funnel plots will show the percentage of babies for whom the audit
standard is achieved in each NNU.
• For each audit standard, some units will fall 2 SDs below the mean
on a purely statistical basis.
•
As there are 4 audit standards, individual units will fall >2 SDs
below the national mean 0 to 4 times.
• NNAP will approach those under-performing on 4 standards, and
possibly some underperforming on 3 standards if their performance
raised alarms (>3 SD below mean) in any of the 4 individual audit
standards.
• Using this approach, NNAP expects that those units with a broad
range of difficulties will be recognised and helped first.
National Neonatal Audit Programme 2011-13
Management of a potential outlier: www.rcpch.ac.uk/nnap
Stage
1
2
3
4
5
6
7
What action?
Providers with a performance indicator ‘alert’ or ‘alarm’ require careful scrutiny of the
data handling and analyses performed to determine whether there is:
‘No case to answer’
‘Case to answer’
The Lead Clinician and Clinical Governance Lead in the provider organisation informed
about the potential outlier status and requested to identify any data errors
Lead Clinician to provide written response to NNAP. (Project Coordinator/Clinical Lead)
Review of Lead Clinician’s response to determine:
‘No case to answer’
‘Case to answer’
Contact Lead Clinician by phone, prior to written confirmation of potential outlier status;
copied to clinical governance lead, medical director and chief executive.
Chief executive advised to inform relevant bodies about the NNAP’s concerns: PCTs,
SHAs, CQC. Informed that the NNAP will proceed to publish information of comparative
performance that will identify providers.
Acknowledgement of receipt of the letter.
Public disclosure of comparative information that identifies providers (e.g. annual).
Who?
NDAU in
liaison with
Clevermed
and TNS
NNAP
Clinical Lead
Provider
lead clinician
NNAP Lead
with NDAU
or NNAP
Work’ Party
NNAP Lead
Project
Coordinator
Provider
CEO
Working days?
10
10
25
30
10
10
NDAU
NNAP Project Board members 2011
Mike Watkinson
Alan Fenton
Neena Modi
Andrew Wilkinson
Roshan Adappa
Jane Abbott
Mary Passant
Eugene Statnikov
Sridevi Nagarajan
Yvonne Silove
Kim Davis
Rita Ranmar
BAPM
RCPCH / NDAU
BAPM
Wales
BLISS
Networks representative
NDAU
NDAU
HQIP
RCPCH
RCPCH
NDAU
www.rcpch.ac.uk/nnap
Any questions?
Comments?